Background

The Royal College of Paediatrics and Child Health – uniquely among the UK’s Medical Royal Colleges – incorporates both leadership in clinical standard-setting and a wider engagement with the health of children, wherever in the world they live. Working globally – through international humanitarian support in some of the world’s poorest countries – is written into RCPCH’s constitution. Since the mid-2010s, RCPCH Global’s portfolio of programmes has expanded significantly. This update provides an overview of where – and how – this is happening. The evolution of our programmes follows a common pattern:

Where:

Given the large scale of continuing need around the world – exacerbated in the aftermath of COVID-19 and wider international turbulence – the College must make choices about where to allocate scarce resources. That choice is determined by a number of factors, including: scale of need (generally we work in developing countries classed as ‘low- or lower-middle income’ countries)1; viability of operating environment (some acute humanitarian crisis, such as hot conflict, limit our ability to intervene meaningfully, especially where other agencies are better adapted for such environments); supportive government signalling interest in and appetite for better child health; presence of a partner paediatric agency (as critical lead for sustainable incountry activity and change).

How:

Much of our initial work in a given country starts with technical training in aspects of clinical care – often in only one or a few selected hospitals. But that is only the start. Training on its own – without sustained supportive follow up delivered in situ in the facilities where trainees actually work – does little lasting good. Training may be a good entry point – building trust in RCPCH’s local relationships and credibility – but it serves as a platform on which we aim to extend in multiple directions:

• Extending from training to mentorship, within each facility on a continuous basis

• Extending from acute emergency management to ongoing management of paediatric cases; from paediatric care to neonatal survival; from neonates to mothers and to quality of perinatal care

• Expanding from individual hospital engagement to multi-sited multi-hospital support, fitted within national maternal, newborn and child health strategy

• Extending from hospital to primary care clinic, strengthening communication, supportive supervision, skills-building and enhanced referral practice

• Extending from secondary hospital care to more advanced tertiary centres, building the necessary clinical capability to manage the rising proportion of smaller, sicker babies and more severely unwell children as routine care improves

• Extending from hospitals and health centres to communities and households as rising survival around birth and in the newborn period lead to incidence of physical and neurodevelopmental disabilities and new dimensions of need in childhood and family support

• Expanding use of data and evidence from local facility audit and feedback to national technical working groups, ministry policy development and government child health strategy

1 Countries with an annual per capita Gross National Income lower than USD$4,086

When:

‘Sustainability’ is the shibboleth of most international endeavours in human development and health. But it takes time. Superficial change, however impressive, can too easily be reversed or simply deteriorate over time. Our aim is to build long-term partnerships in selected countries – building our understanding of the context and supporting the leadership of our local counterparts. It is a strategy based on the belief that depth of relationships, of trust and credibility, is more important than breadth of presence, cycling rapidly from one country to another – and that that depth of engagement is at the heart of genuine sustainability as systems of health and care develop.

Who:

If child health is truly global, it can be acted on from anywhere in the world. From early days when we posted clinicians to work as volunteers in far-flung countries, we have worked to enlarge the way ‘global health’ is understood and delivered (see ‘word cloud’, below). There remains much work to be done ‘in the field’ – but as much and more by locally or regionally recruited clinicians sharing experience as by UK volunteers working with them in hybrid teams. And there is much to be done ‘at home’ too, in the UK and with partners in the developed world – to advocate for adequate international health aid; to provide remote support – revealed by COVID as a whole new dimension of international working – to local clinicians and researchers; to extend and enhance engagement across social groups at home – among minority ethnicities, immigrants and refugees – in the pursuit of greater equality, health and life chances.

In the following sections, we offer a brief overview of each of the major country programmes